Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | LL16195 | OR |
NPI | 1083824031 |
---|---|
Provider Name | Dr. Misty Lynn Carlson |
First Address | Portland, OR 97229-3709 |
Second Address | Portland, OR 97239-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |